Every 5 years Genesis adopts a new diet manual. This year, the centers adopted the Becky Dorner and Associates Diet Manual. The new diets went into effect on May 7, 2013. March of 2013, Diana and I listened to a webinar for the new diet manual. The regional managers had this webinar for RD’s, CDM’s, and Speech therapists.
My in-service assignment was to present the new diet manual information to RN’s, CNA’s, housekeeping, activities, and any other staff member who is involved in the dining room. The in-service is mandatory and will be held 4 different times through out the week for each center. Tygart Center is Monday May 6, 2013 and Wednesday May 8, 2013 from 7am-7:20 am and 3pm-3:20 pm. Pierpont Center’s in-services are Tuesday May 7,2013 and Thursday May 9,2013 from 7am-7:20am and 3pm-3:20pm.
Each in-service began by explaining that CMS (centers for medicare and medicaid services) supports the new diet manual. The new diet manual is recommending as close to a regular diet as possible for each resident. Research presented revealed little benefit to many older individuals with chronic conditions from restrictions in dietary sugar and sodium, as well as little benefit from tube feedings, pureed diets, and thickened liquids. The new standards recommend to clinicians and prescribers that a regular diet become the default with only a small number of individuals needing restrictions. Again, Genesis adopted the Becky Dorner and Associates Diet Manual which is available on the Genesis website and hard copies are also available in the dietary office.
The following diets are available on the standard menu:
– Regular/ Liberalized
– Dysphagia Advanced
– Dysphagia Puree
– Consistent Carbohydrate
– No Added Salt
– 2 gram Sodium
– Heart Healthy
– Liberal Renal
– Gluten Free
The following diets are the House Diets (which will be used first and if there are any restrictions that need to be made, the physician will adjust accordingly):
– Regular/ Liberalized
– Regular/ Liberalized w/ sugar substitute
– Regular/ Liberalized, No Salt pack
– Dysphagia Advanced w/ chopped meats
– Dysphagia Puree
Research indicates that meal intake improves when diet are as near “normal” as possible. In keeping with this philosophy, Genesis encourages liberalization of more restrictive diets when clinically appropriate.
The regular/ liberalized, no salt pack is the same as the previous NAS (no added salt) diet from the old diet manual. The new diet manual’s No Added Salt is more restrictive.
Dysphagia advanced w/ chopped meats combines the previous diet manual’s mechanical soft and advanced mechanical soft diets. The speech therapists have been working with each resident to determine if this needs to be tweaked.
The regular/liberalized diet provides an average of 2500 kcal/day and 87 grams of protein/ day. This is intended for individuals with no dietary restrictions. Small portions and large portions can also be prescribed. If a resident is 78 inches tall for example, they require over 2500 kcal/day, large portions will usually be prescribed so that this resident meets their estimated nutritional needs.
Regular/ liberalized with sugar substitute is intended for individuals with diabetes, or on a weight control plan. Highly concentrated sugars such as regular sugar and soda are not allowed and dietetic products are substituted. Diet hot chocolate, diet gingerale, and diet syrup are available upon resident request.
Regular/liberalized , no salt pack is intended for individuals requiring a mild sodium restriction. This is the regular/liberalized diet but a salt packet will not be provided at meals. If a staff member sees a resident using salt at meals or is requesting salt, let the charge nurse or RD know so that adjustments can be made. You may also educate the resident on why they are not provided a salt pack but you can not not allow the resident to use salt if they are requesting it.
Dysphagia Advanced w/ Chopped Meats is intended for individuals with mild chewing or swallowing difficulty. Meat is chopped or flaked and moistened. Chopped meat is the size of a pea. Vegetables and fruit are the size of a pea. Previously, fresh fruit was not allowed on this diet, if dietary can chop it to the size of a pea, it will be served. Vegetables (whole, chopped, mashed, cooked) are allowed; finely chop fresh onions and tomatoes are also allowed. Toast and grilled sandwiches were not allowed on the previous diet manual. They are allowed with the new diet manual except the crust is removed by dietary.
Dysphagia Puree is intended for individuals unable to chew and/or significantly impaired tongue or jaw movement. This diet is the same as the previous pureed diet except that all foods are allowed if they can puree it smooth. Items such as pizza and fresh fruit will be served pureed smooth. This diet provides an average of 2600 kcal/day and 90 grams of protein.
If any intolerances are observed, inform ST, charge nurse, physician immediately.
A diet conversion chart was created to be placed at each nursing unit so that when a new admission arrives, the charge nurse can easily change the hospital diet to the house diet that coincides with it.
Admission Diet Order–> Suggested House Diet Order:
-Regular Diet, General Diet, Low Cholesterol and/or Low Fat Diet, Bland diet, lactose free or lactose intolerant diet, low residue diet, or GERD diet will be changed to regular/liberalized diet. ** Dietary will identify any allergies or specific food intolerances on the resident tray card
-ADA diet, 1500, 1800, 2000 etc calorie ADA diet, no concentrated sweets diet (NCS), no added sugar diet, carbohydrate controlled diet, consistent carbohydrate diet–> regular/liberalized with sugar substitute.
-No added salt (NAS) diet, Heart Healthy Diet (HHD), Cardiac Diet, Low sodium diet, 4 gram sodium diet, and 2 or 3 gram sodium diet–> Regular/liberalized, no salt pack. ** RD will assess and make any further recommended changes as indicated.
-Renal Diet and Dialysis Renal Diet–> Regular/liberalized, no salt pack, no orange juice, omit banana at breakfast. ** RD will assess and make any further recommended changes as indicated.
-Low Potassium Diet and 2-3 gram Potassium Diet –> Regular/liberalized, no orange juice, omit banana at breakfast.
-Regular with chopped meats and regular with ground meats–> Regular/Liberalized with chopped meats.
-Dysphagia Diet Levels II and III, Advanced dysphagia diet, Dysphagia mechanical diet, Soft or mechanical soft diet–> Dysphagia Advanced with chopped meats.
-Dysphagia Diet level I, Dysphagia pureed diet, pureed diet–>Dysphagia Puree.
-Oral Supplements: Ensure, Glucerna, Boost –> House Supplement.
** Please specify QD, BID, or TID. These will be sent between meals.
Finally I discussed the new diet order and communication form. LPN/RN on admit order, omnicare MD admit order form will not have new diets at this time, they will have to physically write these out. Example: if the resident is a regular/liberalized diet, no salt pack, the LPN/RN will check regular/liberalized on the form and write in the other section: no salt pack.
Diana created a quiz to make sure that each staff member understood the new diet manual.
Overall, I think that the in-services went well and that the staff understood the new diets. Diana lamenated copies of the conversion chart for each nurse’s station. Staff is encouraged to ask the RD for help if need be.